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Thanks for joining us for episode 49 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show!
Today we’re answering the following question from a listener:
“I have a question about ulcerative colitis. My little brother who is 19 was diagnosed with UC about a year ago and he has suffered a lot with the symptoms. He’s on a variety of medications from anti-inflammatory ones to immune suppressants. He’s tired all the time and cannot do much of anything due to difficult symptoms. A few months ago, my mum started making him gluten free, low FODMAP food and using lactose free milk for him avoiding unhealthy foods as much as possible. His symptoms have improved a bit, but they are still severe. I was wondering if you had any recommendations what to do, what to incorporate, and what to avoid. It’s really difficult for me to see him feel so badly all the time, but we don’t have many functional doctors and nutritionists where we live, so help is welcome.”
When living with ulcerative colitis, it can be tricky to find the right combination of things that will work for you as an individual. Are your symptoms still not under control despite current treatment methods or dietary changes? First and foremost, don’t be hard on yourself. Be sure to listen today as we share up to date recommendations for nutrient dense foods, key supplements, and tests that may bring the relief you’re looking for. This discussion can be helpful whether current medications and treatments are not enough, or you’re just beginning to address this health condition.
Here’s what Laura and Kelsey will be discussing in this episode:
- A general discussion of ulcerative colitis
- Why a prolonged restrictive diet may not be the answer
- How an elimination diet can help you discover food sensitivities that may contribute to symptoms
- Even if gluten free, how all grains can be problematic
- Which nutrient dense foods are helpful
- Nutrients important for gut health
- The role of vitamin A and D in immune system function
- How addressing gut dysbiosis is key
- The importance of prebiotics and probiotics, and our recommendations of which to take
- The effect of HPA axis dysfunction on symptoms
- Why starting slow with any supplement is crucial
- Discussion of fecal transplants for ulcerative colitis along with possible benefits and risks
- How demulcent herbs can provide protection and healing to the gut
- The anti inflammatory power of curcumin
- The necessity of testing vitamin D levels regularly
- Why working with a practitioner when introducing dietary changes and supplements can be helpful
- WildFoods.co – Use the code WILDRD for a free gift!
Laura: Hi, everyone. Welcome to episode 49 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is Kelsey Marksteiner.
Kelsey: Hey, guys.
Laura: So Kelsey, how’s your apartment search going?
Kelsey: Oh you know, it’s super fun. Apartment hunting in New York City, and I’m sure apartment hunting anywhere is not very fun. It can be fun because you’re like ooh, I get to live in a new place. But for us, it’s like we’ve been in our apartment for a long time at this point. We sort of somewhat made it a home at this point. It’s a little sad to leave, especially because for the most part we’re moving because there’s issues with the apartment. But otherwise, it’s a really good location that we really like and we have a very good deal on our apartment. So it’s really hard to give that up as a rent stabilized apartment and move out into the Wild West it feels like. Yeah, it’s a little tough to find something that really, you feel good about. I feel like you often see a lot of crappy apartments and then finally you find one that’s going to work for you. So were’ still in the process of weeding out the crappy ones, unfortunately.
Laura: And for anyone who hasn’t been listening to our podcast over the last month, Kelsey’s apartment was found to have mold in it. I guess you said your landlord is not going to remediate the mold, correct?
Kelsey: Well…. if you bring an ERMI test, which is what we did, to a typical New York landlord, I mean I don’t think they’d take it seriously to be honest. We had some water damage. Our bathroom ceiling collapsed a few years ago.
Laura: Oh gosh.
Kelsey: Yeah. So they took out all the drywall and stuff and replaced it. But I have a feeling that it was not totally done correctly. They maybe there was mold and they just didn’t clean out mold or anything. I don’t really know what happened. I actually wasn’t here when it happened. It’s a little unknown. For me, it’s like I don’t even want to deal with it because a lot of time it just causes more problems than its worth.
Laura: Right. And you don’t even know if they’d do it correctly.
Kelsey: Right, exactly. It’s not like I can hire my own mold remediators that I really trusted or anything. Yeah. We debated bout that for a long time, but eventually decided that maybe it’s just time to move.
Laura: Yeah. It’s a bummer. I mean, the place that I live I really enjoy and it’s a great location. If I found out that it wasn’t really safe for me to live here anymore, I honestly don’t know where I would move. I mean, it’s not hard to find a place in Raleigh, but it’s just a very unique location. I’m not sure I’d be able to find something like this that is affordable, and has a little backyard, and drive up on street parking. Yeah, that’s a bummer to have to move, especially if you like where you live.
Kelsey: Yeah. But I’m viewing it a somewhat as a positive thing too because right now in our neighborhood we don’t really have park or anything like that. That’s one thing that I’m like, okay, I’m going to move somewhere next to a park so I can have some nice outdoor place to hang out and stuff. And that is definitely the perfect ending hopefully to this story, is me having some lovely outdoor space. But we’ll see.
Laura: Yeah, that’d be really cool.
Kelsey: Yeah. How about you?
Laura: I was going to say, I don’t know if I have anything super exciting going on. I was just in Florida visiting my grandmother with my parents and trying to get back into some health behaviors now that our Paleo Rehab launch is over, which I feel like as some of our listeners may know, tends to send us into stress overdrive. I don’t leave the computer chair for twelve hours on a single day, that kind of thing. So now that all the craziness is over, I feel like I can start focusing on some of the health improvement type goals that I have had in the back of my mind for a couple of months and just figure out how I can make good habits that are in line with what I want to be doing on a daily basis.
So one example, when I was in Florida I was sleeping in my grandmother’s living room on the pull out sofa and it has a lot of windows. I basically couldn’t sleep much past 6:30 -7:00 because the light was coming in and I was going to wake up anyway, which isn’t necessarily ideal in my opinion. But on the other hand there, I just was like I’m up, I might as well start working and get some work done so I can actually go outside and enjoy the sun or the pool, whatever. So I basically started working at 6:30 in the morning, which to some people might sound horrific to do that. But I was finding that I would be getting five or six hours of work done and then have the whole afternoon to just hang out, exercise, go to the pool, just mess around. And then I could come home, do another couple hours of work, and then be done for the day. It’s one upside and maybe downside of owning your own business, is being able to set your own schedule. I remember when I was in Costa Rica in January, I was getting up literally with the sunrise at 5:30 and that was a lot easier because I was also going to bed at like 8:30- 9:00.
Laura: But there was something about waking up early, and going to bed a little earlier, and getting things done earlier that was nice. I’m hoping now that I can actually go to bed at a reasonable hour and not be at the computer until 11 -12:00 at night, that I’ll be able to get up a little early, maybe make some coffee, and then sit down and do some work for a couple hours, and then be able to take a break and not have to work through lunch, or not have to miss beautiful weather.
Laura: Because we’re getting into that time in Raleigh where like today it was high of like 78, and sunny, and beautiful.
Kelsey: Wow. I’m so jealous.
Laura: We’re in that time frame when I want to be outside in the middle of the day.
Laura: So we’ll see what happens. I always think I want to do this, and then when push comes to shove and its 6:30 and my alarm goes off, and I’m like no.
Kelsey: Right. Never mind.
Laura: Yeah. So we’ll see. It’s a little hard because have black out curtains in my room, which are helpful when I’m sleeping at night. But then I have to basically open them in the morning to be able to wake up. So we’ll see.
Kelsey: Which is blinding, I’m sure.
Laura: Actually, it’s not too bad. At 6:30 in the morning it’s really not that bright, at least right now.
Kelsey: Yeah.Right. I guess that’s true.
Laura: It may get brighter. But we’ll see what happens. I’m trying to shift to a more early day just because I really like having that two phase work schedule where it’s like a couple hours in the morning, take a couple hours off, and a couple hours in the afternoon/evening, and then be done at a reasonable hour.
Kelsey: Right. Makes sense. It sounds nice. Good luck with that, Laura.
Laura: I know, seriously. I feel like I always have all these lofty health goals, like oh I’m going to start hiking with my dog, and I’m going to start sleeping more, and blah, blah, blah. It’s as soon as things get a little crazy in work it’s like pretty much all the behavior change stuff goes out the window, which I’m sure a lot of our listeners understand what that feels like, which is why right now I feel like since things are little less crazy than they’ve been in the last couple months, this would be the time to start building new habits. I feel like that’s really the issue is whether or not something has enough time to become a habit. Because once it’s a habit, it really doesn’t get shifted or disrupted. I mean some habits do, obviously, when we’re in a crazy launch mode when we’re working as hard as we are, a lot of things like habits get lost.
Laura: But I’d say in general even when things get a little stressful, the more something is kind of ingrained into my routine, the more easily I maintain that behavior even when things are a little bit out of control at work, or if I’m traveling, or whatever. I feel like since we had this big launch and now I can kind of take…I mean obviously we’re running the program, but running the program is not anywhere near as much work as actually getting people into the program.
Laura: So we have a couple weeks now that we can take a deep breath.
Laura: Yeah. And so I’m trying to combination use that time to make some big changes in my business and then also make some solid habit changes in my day to day life. So we’ll see how many different things I can handle changing all at once.
Kelsey: Yeah, I know. I’m ready for that too, Laura. It’s funny. I feel like I’m not going to be able have that time until like May or June because I’m speaking at a retreat, which I talked about last time. I’ve got to make my presentations for that, go do that, then I’m going to Tokyo, coming back, then I’ll probably have to move at that point. So it’s like it’s crazy.
Kelsey: I’m jealous that you’re ready to get all these things done. You sound so productive.
Laura: Oh my gosh. Well it’s been on the radar for probably six months now to do the business changes. The health stuff I think it’s been kind of just an upward spiral since I guess probably over the last fourteen months or so after basically my car accident was kind of like the low point where I physically just couldn’t do anything, and I had to really just lay on the couch and not exercise, or sometimes not even work because I was on muscle relaxers and my brain was like, no, not working today.
Kelsey: Forget it.
Laura: But basically, it’s been kind of one decision after the next trying to do personal health improvements. So it started with me joining my strength and conditioning facility and getting a personal trainer. That was kind of the big….there’s this book, it’s by Steven Pressfield and it’s called Turning Pro and its one that Marie Forleo has recommended. And actually I think it’s really helpful and maybe people might be interested in.
Kelsey: It’s a great book.
Laura: Oh, you’ve read it too. Okay.
Kelsey: Yeah, I have.
Laura: So as you know, and if anyone has read this book, there’s a lot about basically taking yourself seriously and deciding to do things to either advance your business, or set a schedule, or add routines that are non-negotiable, just things either in business or in life. It’s almost like setting boundaries in a way but also setting non-negotiable behavior, not rules. I hate to say the word rules, but it’s almost like you make a decision that okay….
Kelsey: Its guidelines, right?
Laura: Right. But you almost have to make the decision that you are a professional, and you need to start treating yourself like a professional, and you need to start putting things in your calendar, and getting a set routine during the week, and just doing things that are what a professional person would do.
It’s been interesting because like I said, I think hiring my strength and conditioning coach was part of that kind of like, okay I’m going to take myself seriously and really get help to get back into shape here. And then it’s just like kind of once you have confidence built from the first step that you take, then you can kind of start making different changes.
Laura: After a while after I was exercising a lot, I was like, okay maybe I need to start looking at my diet and making some changes there. That kind of snowballed, and then everything just builds on itself. I was saying before, it sounds like I want to change everything all at once, which is kind of a little bit like that. But I do things that I started just with the coaching to get the ball rolling for me. And then as that time has gone on, it’s just like I said adding on different layers of things to make me feel like I’m actually acting like a professional and not just kind of acting like an amateur, or whatever they want to call it in this book.
Laura: Now I’m at the point where there’s a handful of things that yeah, they’re going to take a lot of effort and they’re big decisions. And it’s not just like, oh I’m just going to change my business, no big deal.But I think all the other work I’ve put in over the last year plus has kind of brought me to this point where I’m like, okay I’ve done all this stuff which has been great. I feel really confident. I’m really able to handle this. And now I’m going to do X Y Z, and I’m just going to do it, and it’s just going to happen. So that’s been kind of my experience and we’ll see what happens.
I mean, I think it’s so easy to lose track of this stuff especially when work gets crazy, or life gets crazy, or you have to get a new apartment, or you know whatever is in the way of you focusing on your higher priorities. But I kind feel like I’m going into a couple month period where I can actually focus on that stuff and we don’t have eight thousand other things drawing our attention away. So we’ll see.
Hopefully you’ll have the chance when you’re settling back from either a move or your trip to Japan. I’d say make it a priority if there’s something that you really want to do. I have no idea what you’re thinking about as far as….
Kelsey: I have taken that first step. I’ve been going to training for a few weeks.
Laura: Oh yeah. You told me about that.
Kelsey: It’s really fun. I have to say that having a person work one on one with you, oh my God, it makes such a difference.
Kelsey: I feel so much more motivated to go than I would otherwise, I think. That really, really helps me.
Laura: Yeah. What’s the strategy that this person is using?
Kelsey: I mean, I’m really weak at this point because there was probably a good three to six month period where I really wasn’t doing much in the way of activity. And before that I was doing kick boxing and stuff, which was good but it was more cardio than anything else. I kind of just feel really weak at the moment. So we’re just building strength and I’m doing my cardio stuff that I’m supposed to do for my heart outside of it. So literally it’s just strength training.
Laura: So its weight lifting?
Kelsey: Yeah. Exactly.
Laura: Cool. Is it like dumbbells, or machines, or what are you doing?
Kelsey: It’s like barbells.
Laura: Oh sweet.
Laura: Yeah barbells!
Kelsey: Yeah. Very fun.
Laura: Is it a man or a woman?
Kelsey: It’s a husband and wife team that run this place. It’s kind of an interesting setup actually. It’s sort of like, I mean it is essentially personal training. You will get a sort of plan for your day whenever you’re coming that’s written on the board for you. And then the trainer will rack your weights and kind of watch your form and stuff. But there might be a couple other people there at the same time.
Laura: Oh, okay.
Kelsey: Sort of like trade off while you’re resting they might sort of guide someone, or watch someone do their set, or something like that. So it’s really cool because it’s more affordable because of that. So it’s not that one on one time specially that’s your paying for, but you still get the sense of this person is helping me, really watching me, making sure I’m doing it right. Because I have no idea what I’m doing, so it’s really good to have someone take a look.
Laura: Yeah. It’s amazing when you first start, it’s like you don’t realize how much you don’t know until you start working with someone who can see all the areas that you need to work on. I mean, Matt and I are going to be doing a…Matt’s my strength and conditioning coach and I think we’re going to do some kind of one year progress report on my blog or something where he’s going to give me all the stats and stuff that I can show like what the progress has been. It’s really kind of, I don’t know, I’m excited for you. I hope you’re able to continue doing it for a while.
Laura: It’s been really cool for me. I feel like it’s really helped build my confidence in business to be able to do things that I didn’t think I could do from a physical perspective.
Laura: Like today was funny. I was doing a combo heavy front squat and then chin-ups. And Matt was like, okay so you’re going to do two chin-ups and then I’ll help you with the third one. I was thinking to myself, I haven’t done chin-ups in like almost a week. There’s no way I’m going to be able to do two. I was like, okay well you’re going to help me if I can’t do two, right? He’s like, just do it, in like typical Matt style. I was like alright, whatever, I’m just going to try it. I ended up doing all three by myself.
Laura: I was like, oh my gosh! I got so excited about it. It’s funny because Matt is like the most non-emotional person ever and he’s like, good job. And I’m like, wait a second! No, you don’t even realize I just got three chin-ups!
Kelsey: I need more than that!
Laura: I know. He gave me a fist bump at the end of the session, like saying oh great job on your PRs today, which is just funny.
Laura: I feel like for me, it’s gone from…you know if you’re working out alone…like I always love exercising, but sometimes working out by yourself your just like ugh, this again. I’m so bored. Then I’ve done other training programs that I just, I don’t know, I wasn’t that excited about going. And now I’m at the point with my work with Matt that I’m like…I told him the other day, I’m like I’m kind of sad on Wednesday because then I know I’m not going to come back here until Monday. So maybe I need add a third day because I’m so sad when I’m going to be five days in between sessions.
Laura: And not everyone’s going have that experience. Obviously there’s people out there that hate weight training and that’s totally cool. There’s no one exercise that you have to love. But I think it’s a good example that when you find something that you really enjoy, and also is safe, and you’re not going to get injuring doing, that it doesn’t take a lot of intrinsic, well its exactly intrinsic motivation. I meant extrinsic motivation to be like, oh I have to go to the gym because if I don’t then this is going to happen. It’s almost more like, wow I can’t wait until my gym session with my coach today.
Kelsey: Yeah. It’s so fun. I do really look forward to the training sessions because it’s just like, I don’t know. Even if I’m not looking forward to it necessarily right before I go, I’m kind of like ugh I’m tired, or I don’t feel like doing it, whatever. Once I get there, it’s really fun and I’m always glad that I went and did it.
Laura: Yeah. That may change. You may get to the point like me where it’s like, yay its Wednesday! I get to go train today! Unless I’m sick and physically I’m like I don’t think I should do this, there’s never any time where I’m like, oh man, I don’t want to do this right now.
Kelsey: Well, we may be a little different in that sense. I’ve never been someone who is like crazy excited about exercise. It’s never been that oh my gosh, yay, this is so fun! So maybe we’re a little different.
Laura: Well, I will say if you start physically doing things that you never thought you’d be able to do, it’s addicting.
Kelsey: Yeah. I’m looking forward to it.
Laura: That’s the experience I’ve had. I mean like I said, I don’t get super excited about going to the gym just to go on the treadmill or something obviously.
Laura: Honestly for me it’s more, oh I wonder what I’m going to do today. It’s exciting and it’s kind of just more playful than just the typical workout routine that’s like, oh I’m just trying to keep in shape, blah, blah, blah.
Kelsey: Right. Totally.
Laura: Anyway, I’m sure our listeners are like, alright ladies. Let’s get to the point here.
Kelsey: Done now.
Laura: But yeah, I think it’s just a good example. I know exercise is kind of an easy thing to talk about when you talk about working with a coach. But I think when it’s a good fit and it’s something that’s helpful, I don’t know. It makes everything in life a little bit easier because you start to build this confidence that you can do things and that if you put effort into stuff you’ll see results. I don’t know. Even if it has nothing to do with health stuff, I just feel like it really translates into a lot of different areas of life where you just start to feel more able to do what you want to do.
Kelsey: Yeah. Totally. I’m hoping that is the case for me. We’ll see.
Laura: Yeah. Well, if you ever come to visit me in Raleigh, I’ll have to bring you to my gym and we’ll have to lift together or something. That would be fun.
Kelsey: Gosh. I hope I gain some strength before then.
Laura: Well anyway, we’re going to move on to our question for today. But before we do that, let’s hear a couple words from our sponsor.
Alright. Our question today comes from Sophia. Her question is “Hello, and thanks for your extraordinarily lovely podcast.”
Well that’s very kind of you, Sophia.
“I have a question about ulcerative colitis. My little brother who’s 19 was diagnosed with UC about a year ago and he has suffered a lot with the symptoms. He’s on a variety of medications from anti-inflammatory ones to immune suppressants. He’s tired all the time and cannot do much of anything due to difficult symptoms. A few months ago, my mum started making him gluten free, low FODMAP food and using lactose free milk for him avoiding unhealthy foods as much as possible. His symptoms have improved a bit, but they are still severe. I was wondering if you had any recommendations what to do, what to incorporate, and what to avoid. It’s really difficult for me to see him feel so badly all the time, but we don’t have many functional doctors and nutritionists where we live, so help is welcome.”
Kelsey: Alright. This is a great question. I think probably to start we can talk a little about ulcerative colitis in general. We don’t know entirely what causes ulcerative colitis. The idea is that it’s essentially an autoimmune type condition where the body is sort of attacking itself and it’s just sort of reacting to things in a way that is not normal. And it’s obviously an inflammatory bowel disease, so you have a lot of inflammation going on, which causes a lot of the symptoms that people with UC experience. So I just wanted to get that out of the way for people aren’t super familiar with it just so you know where we’re coming from when we’re talking about the solutions or ideas we have for this person.
I think probably, Laura, you’re going to talk a little bit about the diet side of things and then I’m going to talk sort of about supplementation a little bit. Then I think that would probably make sense to come after the diet. Do you want to start with the diet recommendations that you have?
Laura: Yeah, sure. Well I will say with ulcerative colitis, I have a couple friends that have it and I have a couple of patients with it. It’s one of those things where it comes and goes as far as the symptoms are concerned. So even if someone is doing everything a hundred percent perfectly, it doesn’t mean they’re going to feel great all the time.
Laura: We say perfect as in literally you’re doing everything you can to make things work. And maybe you’ve figured out trigger foods, maybe you’ve done all these things that are helping you feel better. But it doesn’t mean you’re always going to feel great, or even feel a hundred percent most of the time. I just wanted to kind of put that out there because I would feel bad if somebody thought that the reason their UC was flaring or if they were having symptoms was they weren’t doing something enough.
Again, I have a friend in particular who is potentially smarter than I am when it comes to nutrition, and she’s done so much research, and she does so many good things with her diet, and her exercise, and her sleep, and all that stuff. I think she’s doing quite well compared to what she used to be doing, but there’s still times when she’s pretty sick.
Laura: It’s something that you’re not necessarily going to be able to solve with food. I almost feel like that’s more of a warning against going on any sort of really, really, restrictive diet for too long because I think sometimes people believe that, oh if I go on a GAPS diet for a year, then this will fix my UC. And it just doesn’t work that way. I just wanted to mention that first so that way if Sophia’s brother does start making some changes, like I do hope he gets some relief and that would be awesome, but I also want him to not feel guilty if he’s not on some really, really, restrictive diet because it’s not going necessarily going to be helpful.
Kelsey: Very good point.
Laura: Speaking of restrictions, there are a couple of things that I think Sophia’s brother could potentially try removing just to see if it affects his ulcerative colitis symptoms at all, and that’s mostly because of the autoimmune element in UC. Without him necessarily being able to get tested for food sensitivities in whichever country that they’re in, I would like him to do something like an autoimmune type food elimination for at least 30 days, probably closer to 60 for someone with an autoimmune disease just because of how long it can take for the cells to regenerate when they’ve been damaged by food intolerance for that long.
We don’t know a ton about Sophia’s brother’s diet, but it sounds like he’s generally trying to eat pretty well. I would expect that he’s still eating some things that maybe either aren’t “healthy” or possibly not on his gluten free, low FODMAP, lactose free plan. But let’s just say he is sticking a hundred percent to gluten free, low FODMAP, lactose free. There may be a couple of things he’s still eating are causing problems. When we talk about gluten free, that doesn’t necessarily include grains. And sometimes for people with ulcerative colitis, grains even if they’re gluten free can be a problem. I’d say removing any sort of gluten free grains that he’s eating to start with just to see if that helps. I’m not arguing that he…if it does help to remove these grains, that he’d have to be grain free forever. I do have clients that can tolerate things like rice, or buckwheat, which is technically not a grain, but things that are grain-ish like that. But I think it would be worth removing for 60 days to see if that makes any difference.
Another food that he’s clearly eating is milk and dairy products. Dairy is one of those foods that tends to be problematic for a lot of people with autoimmune disease, not everybody, but certainly a decent number. That would be another food I would definitely recommend removing for 60 days. That’s not just milk. That’s cheese, that’s yogurt, that’s butter, anything that’s dairy essentially I would say remove for 60 days and then you can try reintroducing it.
Then the third food that I’m assuming he’s eating, but we’re not sure because there’s no information about this, would be eggs. Because eggs are one of those foods that even know they’re super healthy and most people eating many eggs a day or per week is a great healthy to do, for people with autoimmune disease, egg whites especially tend to be something that can cause immune reactivity. I’d say if he is eating eggs right now, maybe taking eggs out. I mean 60 days with eggs for whatever reason I feel like probably isn’t necessary. I think maybe he could add in some egg yolks after 30 days if you wanted to try to see if those are helpful for him to eat because there’s a lot of nutrition in egg yolks that I’d want him to be eating if he can tolerate them. Whereas things like gluten free grains and even dairy in the short term really isn’t providing specific nutrients that would be helpful for gut health other than possibly some fat soluble vitamins and some probiotics if it’s a fermented milk product. But I think he could probably go a little longer without milk or grains if he adds those egg yolks back in after 30 days and sees how he tolerates those.
The nutrients in egg yolks that I’d be mostly interested in him getting a decent amount of would be choline and vitamin A especially. Those two. Vitamin A is very important for immune function. It helps modulate the immune system. If it’s an overactive immune system, it brings it down. And then if it’s an underactive system it brings it up. So it makes people who have either low immune activity or high immune activity more normal. And then choline is very important for gut health. Its helps with gut motility. It’s something that you can get from other foods.
The main other food that he would potentially be able to get this from if he can’t eat egg yolks is liver. Liver is obviously very high in vitamin A as many of our listeners know. It’s super high in B vitamins. It’s also a high source of choline. I would actually want this young man to add liver in if he can tolerate it or if he’s willing to, a good 4 -6 ounces a week at a minimum to be getting some high nutrient dense food.
And then the reason that I mention nutrient density is because with UC a lot of times there’s a significant amount of malabsorption of nutrients. You may be eating a pretty healthy diet, but whether or not your gut is able to absorb those nutrients is the question. And with something like liver, you’re getting such a huge hit of nutrition from a single food that it would be very difficult to not absorb at least a significant chunk of that. He may be able to eat a little bit more than the average person because of probably having some lower absorption of nutrients. So whereas I might say 4 ounces a week for the average person, maybe he can do like 6, up to 8, if he hasn’t had liver, or maybe he’s never had liver, if he doesn’t have it every week just to kind of get those nutrients back up to where to where they need to be. Because with his fatigue, and obviously with the medication he may have fatigue for a lot of different reasons. But a lot of times with IBD, fatigue is also due to those nutrient deficiencies that come from malabsorption. Things like iron, zinc, lots of the minerals tend to be poorly absorbed. And then also the water soluble vitamins tend to get lost easier. So things like the B vitamins. I would definitely have him add liver.
And then some of the other nutrients that I would hope he’d be able to get extra from his food, zinc is a very important nutrient for gut heath. It helps close the tight junctions of the gut lining. If you have something called leaky gut, it can really help reduce the permeability. Food that are high in zinc that I think would be a good thing for this man to add would potentially be shellfish. I say shellfish because they’re so high in zinc, and they are allowed on the autoimmune Paleo diet, and they’re not going to cause the same type of gut symptoms that some other zinc rich foods like nuts and seeds for example would cause. I would definitely like this young man to add liver and shellfish to his diet, maybe some egg yolks if he tolerates them after removing eggs for a couple of weeks.
I’m trying to think if there any other nutrients I would want him to focus on in his food, because I know you’re going to talk about supplements. But as far as food is concerned, those would probably be the main nutrients I’d like to see him increase in his diet if he’s not already eating those foods.
Kelsey: Yeah. I was going to be mention A and D. So I’m glad you mentioned liver because that’s a very good way to get those. He can add on additional supplementation. Or if he, for example, can’t tolerate or just really does not like liver, I would still want to see him getting specifically A and D because they have such an immune modulating effect that can be very, very helpful for UC.
But, yeah, I think you kind of hit on most of the nutrients. And your right, that absorption issue is a really, really big issue for people with UC. Having a very nutrient dense diet certainly can help mitigate that. Sometimes I would say that a multivitamin can be useful as long as it’s a high quality one. Just because exactly what you were saying before, you’re just getting so much higher dose and hopefully you can kind of absorb that a little bit easily, or you’re getting more of it then you would from lower nutrient dense foods. He could even add on a multivitamin on top of even a fairly nutrient dense diet. I think that could probably potently be useful for him too.
Laura: One more thing before I let you move on to the supplements that I just realized I forget to mention was if he is eating plant foods, I would suggest mostly eating cooked plant foods, and that includes fruit if he’s eating fruit. And if even cooked foods bother his gut at all, then look at actually pureeing those plant foods. Some of my clients with severe IBD, or even IBS, or any sort of severe gut symptoms, a lot of times raw or lightly cooked vegetables are not easily digested for them. What I usually recommend to those clients, especially if they’re seeing bits of undigested plant matter in their stool, which is pretty common for people who are having a lot of digestive issues, is that they cook and puree their vegetables.
So boil them prolonged enough so that they’re pretty well cooked, and then blend them up. I usually like to use some kind of fat, so either butter, coconut oil, or even animal fats like lard or tallow you could use if you can’t use butter. My favorite is butter just because of the flavor. But just some healthy fat and some salt and blend that up until like a side dish. It sounds kind of gross, but I think it’s actually kind of tasty and a lot of my clients really like the taste. And it’s also significantly less challenging on the digestive tract. Especially with UC where you have that physical inflammation that’s happening, a lot of times roughage and very fibrous vegetables or plant foods in general can actually exasperate that physical inflammation that’s happening. And so blending the vegetables after they’ve been well cooked I find tends to work for my clients that do have severe gut issues and maybe some absorption problems.
Kelsey: Yeah, definitely. I totally agree. That’s usually one of the first recommendations for anybody with digestive issues just because it really can help a lot and it really isn’t as disgusting as it sounds. You’re right, it sounds so gross.
Laura: I know. It sounds weird but then it ends up just being this nice mashed green side dish.
Kelsey: Right, yeah.
Laura: I mean I eat it and I don’t have any major digestive problems. I think that can be really helpful because of the physical irritation that happens when you eat things like kale, or apples, or that kind of thing.
Kelsey: Yeah. I totally agree. Before I jump into the supplements here, I do want to just talk about some underlying sort of functional medicine concepts that we can talk about in relation to UC, which are dysbiosis and HPA axis dysfunction. First let’s talk a little bit about dysbiosis. And when I say dysbiosis, what I mean by that is any kind of imbalance in the bacteria of the gut. Now whether this happens in UC because UC causes microbiome disruption, or if microbiome disruption causes UC, we don’t really know. We don’t know what the chicken or the egg is in this situation. But there is some evidence that there is some degree of dysbiosis in a lot of people with ulcerative colitis. It’s worth looking at that and seeing if you can find anything if there is an imbalance and then treating that with a practitioner. I think it can be very useful.
Typically the way you’re going to look at that is through a stool test. And this is through functional medicine labs like Genova or Doctor’s Data, labs like that that do a little bit different kind of testing than a typical stool culture that you would get like at your gastroenterologist. If you’ve had a stool test before just at your normal GI doctor, this is a different sort of thing. It’ll actually tell you how much good and bad bacteria you have in your gut. It can give you your calprotectin levels, which is a marker of inflammation, which some of you with UC may have already gotten elsewhere if your doctor is looking at that. But you can also just get it another test of that to see how things are doing in your gut inflammation wise, because that’s obviously a very big part of the symptoms with UC. I’ll touch back on this in a little bit when I talk about the supplements because this ties back.
But before I do that, we probably also want to talk about HPA axis dysfunction because with any sort of chronic illness, I think it’s really common to have HPA axis dysfunction. And again, chicken or egg, we don’t totally know but that doesn’t mean that you shouldn’t treat it or deal with it. This would be something that you can look at from a stress perspective, and not even just emotional stress like whether you personally feel stress, but thinking about it from the perspective of does my body feel stressed? And of course if you’re dealing with a lot of inflammation, which is typical of UC but also quite typical of a lot of other chronic illnesses, a lot of times your body is feeling very stressed and you will have HPA axis dysregulation.
When I say that, I’m talking about this “HPA axis.” So that stands for hypothalamic pituitary adrenal axis. So it’s just the connection between those organs in our body that is the stress control center of our entire body. When that gets dysregulated it can cause a lot of problems. This person mentions that he’s having fatigue a lot. And like Laura mentioned, that could be medication related, but it also wouldn’t surprise me if he has some degree HPA axis dysregulation that’s a least playing a part in those fatigue levels. If nothing else, focusing on the HPA axis could potentially make him just feel a little bit better overall and feel more able to cope with some of the symptoms of his chronic illness. I just wanted to mention that real quick before we jumped into the supplements because both of those things are going to be something that you should really look at with any chronic illness, but especially dysbiosis in any sort of gut illness.
With that said, if you find out that you have some sort of dysbiosis, so some sort of imbalance of the gut bacteria, one thing that can be really great to help to turn that around is prebiotics. We’ve talked about prebiotics probably a lot on this show because they’re pretty great supplement. But prebiotics essentially just feed good gut bacteria. And my favorite one, or I guess I have two favorite ones. One is Galactomune, which I tend to use a little bit more nowadays because I find that people do a little bit better with it, especially gut clients for some reason. Its better tolerated.
Laura: Now Galactomune is the brand name.
Kelsey: Yeah. GOS is what we call it. Then the other one that I use often is FOS. And that one I just use the NOW Foods one of that. The Now Food is the brand. But FOS is the compound that you’re consuming, the actual prebiotic name. That one I probably would do second like if you don’t tolerate the GOS or Galoctomune if you have access to that particular supplement. But just because I typically do find that the GOS does a little bit better than FOS. Would you say the same, Laura?
Laura: Yeah. I haven’t seen as much side effects with the GOS.
Laura: It just seems to be a little bit more gentle.
Kelsey: Right. So definitely start there. But if you don’t tolerate it, don’t be scared off of prebiotics. I would definitely try FOS. There’s some others too, but those two are the ones that I like the most and that I’ve kind seen the most research on. I caution you away from resistant starch like potato starch. I know that’s probably something that people hear a lot about these days. Maybe its heyday is over. I don’t know. I feel like I did used to hear more about it than I do now. If you’ve been wanting to try that, I would probably say hold off on that. I’ve just had a lot of people that don’t do quite well with it. I would definitely suggest the GOS or FOS over that. They’re different. They work in a little bit different ways. But the prebiotics FOS and GOS…try GOS first, will tend to be much better than resistant starch in terms of side effects and things like that.
Laura: One thing about the resistant starch is if somebody does have a stool test, they should really check…honestly when I say they should check, they should have a practitioner check to see if any of the pathogens that come up are ones that feed on resistant starch because I’ve seen that before in some of my patients who had reactions to resistant starch that they had certain types of pathogens. I know Citrobactor tends to be one that feeds really well on resistant starch. Just be careful with that. I think sometimes people just hear about these supplements and they’re like, oh I’m going to try potato starch and see show that goes, which I’m not saying it’s not going to help certain people.
Laura: Just be careful because if you have a pathogen that loves that stuff, then you’re probably not going to have great results with it and it could actually makes things worse. So just be careful.
Kelsey: Right, yeah. Absolutely. Very good point. If you have dysbiosis that comes back on a stool test, and this is a test you need to get through probably some sort of functional medicine practitioner, definitely prebiotics should be on the list to potentially try. But do know that you can some degree of negative symptoms when you first start just because of how prebiotics work. When you take a prebiotic and your gut bacteria is exposed to a prebiotic, the gut bacteria essentially eats the prebiotic and produces gas as a result. You can definitely have some bloating a little bit, sometimes people will get a little bit of abdominal pain. It shouldn’t be anything terrible for sure, but there will be some degree of gut symptoms usually and those are usually more pronounced in someone who already has gut problems. So just know that that can happen. It is normal for that to happen. And for people with a gut issue, I would just start super, super low and go very slowly with increasing the dose. Because you actually need, at least according to research, you actually need a fair amount of prebiotics to truly make a difference in how much good and bad bacteria are hanging around in your gut. I think for GOS its 5 grams and for FOS its 10 grams, if I’m remembering that correctly. That’s a fair amount that you’re going to take over the course of the day. So I would definitely not start there. I usually have my patients start with about 1/8 of a teaspoon, which is like nothing. You really do have to start very low and work your way up very slowly. But usually with that kind of pattern of increasing, most people tend to do pretty well with it even if they have a gut disorder.
Alright. Cool. So the other thing you can do, obviously if you have any sort of gut issue or dysbiosis, and even if you don’t have dysbiosis, or you haven’t tested for dysbiosis, I would still recommend using probiotics because there’s actually been quite a bit of research showing that probiotics can be very, very helpful for dealing with UC. For example, most of you probably, I guess I shouldn’t say most of you, but a lot of you have probably heard of a probiotic VSL#3. And there’s actually a study done on that probiotic that showed, I think it actually put 77 percent of the people who took it into remission, which is pretty remarkable.
Laura: From UC specifically?
Kelsey: Yeah. That sounds like almost too good to be true, potentially it is.
Laura: Well remission is not necessarily permanent.
Kelsey: Right, exactly. It seemed to work quite well for a lot of people. That’s at least in the US. I don’t know, I can’t tell exactly where these people are located, but at least in the U.S. that’s very easy to come by. You can just go to your local drug store and a lot of times you’ll have it there. That’s a good one to try. You can also order it online. I think its available in a lot of other countries too, so hopefully these people can find that near them because that would probably be my first recommendation to try for a probiotic. And that’s a quite a few different probiotic strains put together in one product. It’s actually quite high of a dose of probiotics in one pill or one packet. You’re getting a lot of good stuff going in, which is great.
You can also try, there’s another strain of probiotics called Lactobacillus GG, which commercially at least is available in the probiotic Culturelle. Again, that’s really easily found at drug stores. In fact I don’t think I’ve ever been to a drug store that doesn’t have Culturelle.
Laura: Yeah. I think it’s one of the ones that I mean it’s basically everywhere, honestly.
Kelsey: Yeah. So that should be super easy to find. So if VSL#3 proves to be more difficult than I’m making it sound to find, hopefully you should be able to find Culturelle.
Laura: I think even in other countries, too. If you have Amazon, or there’s a website called iherb, that one’s available in most countries. I almost think anyone could be able to get Culturelle. I mean I shouldn’t say no matter where you are, but most countries that have any sort of normal Amazon access or iherb access, they should be able to get that.
Kelsey: Yeah. Hopefully that one is even easier to find. And that one is also shown to be helpful for inducing, or no, sorry I made a mistake. That one actually helps to prevent relapse. So if you’re already in remission, Lactobacillus GG, or Culturelle, has been shown to help prevent relapse of UC. You could start with VSL. And this is all based on research, so how this works on an individual level is definitely not confirmed a hundred percent for every individual. So you sort of need to play around with it.
Laura: Well, even like you said, if it’s a 77 percent success rate, then 23 percent of people aren’t finding success.
Kelsey: Exactly. I think actually a few had, and it was a very small percentage, it was maybe 3 percent I think of people had somewhat of a negative effect. That could be something really minor of course, and probably for probiotic it was a pretty minor side effect. I actually didn’t see what it was in the study, but it probably wasn’t terrible. Otherwise they usually wouldn’t recommended something like this even if one person had some sort of terrible, terrible side effort.
Kelsey: It’s generally very safe to try. 77 percent of people did really well it. So I’d try that first if it’s available to you. The other one that can help to induce remission is called Lactobacillus Plantarum 299V. I know, all these strains sound really amazing. That one is available here in the U.S. from Jarrow, the brand, it’s called Ideal Bowel Support. That one can help induce remission as well. Definitely not as easily found I’d say. You wouldn’t be able to find that in a drug store really.
Laura: I think Jarrow they sell at Whole Foods and stuff like that. But you’re probably just better off just ordering that online.
Kelsey: Right. Exactly. Yeah. But either one of those would be good. I think VSL#3 probably has a little more research behind it.
Laura: I find VSL#3 can be really hard to find for people.
Kelsey: Really? I’ve actually found that it’s pretty easy.
Laura: Oh, really? I think for whatever reason I’ve had some clients that…I thought they sold it in CVS and those kind of places.
Laura: I don’t know. I’ve told some clients about that and they were just like, they didn’t have it at my CVS.
Kelsey: Yeah. It’s not every CVS. I always tell people go to the VSL website and search for a pharmacy near them because it’s definitely not as widespread as Culturelle.
Kelsey: Culturelle you literally can find at very drug store ever. VSL is like select drug stores. But something like Jarrow would pretty much never be carried in a drug store. Yeah. It depends on what’s available to you. If you can’t find any pharmacy on the VSL website that’s near you that carries it, then obviously either ordering online from VSL or ordering something like the Jarrow Ideal Bowel Support is going to be a lot easier.
Kelsey: Cool. Then the Lactobacillus GG, the Culturelle, that helps to prevent relapse. You could start with the VSL#3 or the Jarrow probiotic, either of those, or potentially both. I mean there’s no reason I would say you couldn’t do both either.
Laura: Other than cost, because I know VSL is very expensive. I don’t know if the Jarrow Bowel Support is.
Kelsey: Yeah, I think it’s less expensive because VSL is very expensive. But other than cost, there’s no reason you couldn’t do both unless you just didn’t want to. I would say though if you’re going to do both, or anytime you’re adding in supplementation with a gut disorder, you want to do it one at a time because if you react to something in a supplement, you want to be able to tell what supplement caused that problem. Because if you take a million things at once and like overall it seems to be helping, but there’s something that is bothering you in some capacity, it’s just impossible to tell what it is and then you have to take them all out and sort of start over. It’s definitely much easier to just start from the beginning adding one at a time and potentially starting at a lower dose. With capsules that’s obviously hard to do. But VSL, for example, comes in a powdered format if you want to try that first and maybe take half of a packet or a quarter of packet to start with and build up to the full dose.
The other thing that in terms of dysbiosis to think about here is fecal transplants. Those are gaining a lot popularity, or I guess I should say people are talking about them a lot. I’m not sure they’re actually done, but it’s more and more of these days. But for UC, it seems to actually be somewhat controversial. Not that you’d get sort of like a negative effect of a fecal transplant, but there’s just kind of differing studies in terms of their results showing…some studies will show for UC patients a fecal transplant works really well, and it induces remission, and it’s awesome. And then other studies really show no difference what so ever. That can make it a little bit hard to really recommend fecal transplants.
When I think about these things, I think about it form an individual’s point of view. If I was someone suffering from UC and I heard that a fecal transplant could potentially be useful, but it could potentially not do anything, but if there wasn’t really a negative effect, I probably would at least personally probably would just want to try it to see if it helped me. So that’s something you may want to explore and just decide if it makes sense for you. It can be really hard to find someone to do it. I’d say that’s probably the biggest obstacle.
Laura: Yeah. And it can be really expensive if you’re getting it done in a way that’s safe and appropriate.
Kelsey: Yeah. Don’t do this yourself, please.
Laura: I will say I have had a handful of patients that had bad reactions to fecal transplant.
Kelsey: Interesting. Ok.
Laura: I mean it’s hard to know why. Fecal transplant is such a new therapy that we don’t know why in a research study, it didn’t show any negative effect. Maybe they were being really, really careful about the strains and making sure everything was….
Kelsey: Or who they’re taking it from, things like that.
Laura: Making sure that everything is healthy strains and that they’re not introducing pathogens or anything like that. And maybe the clients that had reactions didn’t have that level of oversight. It’s one of those things that I would say is definitely last case option.
Kelsey: Oh for sure. Yeah.
Laura: Just because even though in the research it doesn’t show necessarily significant negative effects, that doesn’t mean that that can’t happen. Like I said, I had at least two or three people that…one person significant new symptoms, things like reflux, that kind of thing.
Kelsey: Wow! That’s really interesting. I had a handful of people have them too, and the worst I’ve heard is that nothing happens, like nothing changes. But that’s interesting you’ve had people with negative. I mean it makes sense that that could happen. There’s some much that we don’t know about the microbiome.
Kelsey: There’s strains we don’t know even exist, I’m sure. And we don’t know if there’s anything else in feces that could potentially cause problems for particular people, or turn on certain genes, or things like that. So it’s just a huge unknown and that’s why it’s not very popular right now. It’s really only popular in the conventional sense for things like C. diff where that can be a life threatening thing to have and so they’re more willing to do somewhat out of the box things like a fecal transplant.
Kelsey: there is research on fecal transplants for UC. But like Laura said, it should definitely be a last resort and for a lot of people that risk may not be worth it. So that’s definitely something to really think hard about. Really try everything you can first. And then absolutely of course talk it over with your medical professional. It can’t really be a decision that you’re making on your own because you’re going to work with someone to make that happen if it’s something you do decide you want to do.
Laura mentioned the immune vitamins that are important, so I won’t go over those again. But also I just want to mention that both prebiotics and probiotics also have significant immune effects as well. Even if you’re not taking them to specifically induce remission like in these studies, that’s what they were looking for. If nothing else, you’re supporting your immune system and kind of turning on your T regulatory cells, which as they sound, they regulate the immune system and that’s exactly what we want in a condition like UC. Those can be useful outside of curing dysbosis, or anything like that. They actually have effects of the immune system as well.
Actually I have two more things that I want to mention. I’ll go through them pretty quick. One is demulcent herbs. So things like slippery elm root, marshmallow root, deglycyrrhizinated licorice, all of those things are like I said considered demulcent herbs. Basically what they do is coat the tissue in the gut. So if you take it as a powder it will also coat the esophagus. That’s why it’s useful in things like GERD. But it will coat any tissue that it comes into contact with to create sort of a barrier from inflammatory things. Sort of anything causing inflammation, it’s going to create a barrier in between that and your tissue. Then it actually helps to heal inflammation as well. But that said, some of these things people can react to poorly, especially with gut issues. So I feel like every supplement with gut issues is like a very…you have to really think of the cost benefit ratio. And for some people, you just have to try it before you know because there’re a lot of reasons they can be very, very useful. But if you respond poorly to them, obviously you don’t want to take them. But it may be worth trying. You sort of have to think about that cost benefit ratio and is it worth it to try something that could potentially be very useful? But also you may respond poorly to it and kind of have to take a little a bit of a step back and recover from that poor reaction.
For any of these things, I really do recommend working with something just because it can make that process easier and they can make decisions based on things that you have reacted to in the past to come up with a supplement protocol that makes the most sense for you personally. Because without having talked to this person, knowing what he’s reacted to poorly in the past, it’s a little hard to say. But these are all of the things I think about when I think about UC. So hopefully that makes sense.
Then the last thing I’ll mention is curcumin. Curcumin is really, really anti-inflammatory and when you’re thinking about IBD, obviously inflammation is a very big part of that. So any way that you can reduce inflammation is a great thing to do. So he’s on anti-inflammatory drugs, but to sort of get an additional anti-inflammatory effect and in a more natural way, he could try curcumin. Sometimes you can wean off other drugs if that’s a goal of his at any point by using more natural sources. It’s totally up to him how he wants to do things and how his doctors think things should be done. But all these things are supplements to try or potentially just think about trying. Working with someone while you add these in is going is going to be a great idea. I wouldn’t necessarily say you want to just jump into a protocol like this all on your own. You can, but again, do one at a time absolutely at the very least. I’d probably say to expect some of the supplements are not going to treat you well and that’s’ just a totally individual thing that really, it can’t be predicted completely. But by working with someone who knows your past, they might be able to tell you I don’t think this supplement is necessarily a good idea for you.
Laura: Right.That’s a good point.One last supplement that I wanted to mention that you had said something about before that in the nutrition recommendations I didn’t quite cover is vitamin D. Vitamin D is one of those nutrients that we know significantly affects autoimmune disease risk and also severity if it is low. Now, a lot of doctors, well I should say a lot of integrative physicians, will try to push vitamin D pretty high in clients like someone with UC. I don’t know how comfortable I would feel with that. I would say if this young man wants to make sure his vitamin D levels are in like the 40 to 60 range, I’d feel comfortable with that level.
And a lot of time people with UC have lower vitamin D because of the poor absorption. Maybe they’re losing fats in their stool, so they’re not being able to make as much cholesterol. If his vitamin D is below 40, he may want to add some supplementation. And it depends on how low it is because if it’s in the low 30s or high 20s, maybe just 1000 IU per day. If it’s in the teens, then you’d probably want to do like 3,000 to 4,000 IU per day until it’s at least up to 30.
Kelsey: Yeah. That’s a really good one to mention. It’s included a little bit in some of the foods that you talked about. But it can be really hard to get enough if you’re already low in vitamin D.
Kelsey: So maybe food would be fine if you’re already sufficient and you’re getting some sun. But otherwise, you probably do want to supplement to some degree.
Laura: Well and actually, only about ten percent of our…unless you’re eating things like cod liver, like literal cod liver.
Laura: I mean that’s the only food I can think of that’s a really high vitamin D source.
Laura: But even if you’re getting sunlight exposure, if you’re on any sort of inflammatory state, that can actually reduce you’re conversion of vitamin D from the pre hormone. I’d say for most people with any sort autoimmune disease, that’s something you want to keep track of is what your vitamin D levels are. Because you may even if you’re out in the sun, even if you’re eating fatty fish, and egg yolks, and that kind of thing, you may not have as high of a vitamin D level as you should to keep inflammation in check and keep your immune system functioning normally as possible. Definitely something to keep an eye on. Not that everyone needs to be supplementing, but it’s something potentially helpful if that person is lower than like I said 30. I mean I’d prefer in the 40s for someone with autoimmune disease, but even if they’re in the 30s I’m not too, too worried about it.
Kelsey: Yeah. I tend to push it a little higher with autoimmune, but I agree. There are some doctors out there that are pushing like even to 100, which is crazy to me. So yeah, you don’t have to do that, but you definitely want to at least be in range for vitamin D and I’d suggest testing at least twice a year. It also kind of depends on where you live. Like if you have four seasons a year and a good portion of that you’re not spending a ton of time outside, I’d probably say more than twice a year is warranted for testing. And especially if you already have some disease that necessitates going to the doctor a little more often, that tends to be easier to get that tested more often just to make sure that you’re always in a good level for your vitamin D because it plays such an important role in the immune system.
Laura: Yeah. Unfortunately, some of my international clients have such a hard time getting these tests.
Kelsey: I know!
Laura: It’s crazy.
Kelsey: It’s sad. Yeah. It’s so important.
Laura: It’s just silly because it’s like, vitamin D, really? They wouldn’t do vitamin D for you?
Kelsey: Nobody’s arguing about vitamin D.
Laura: I know.
Kelsey: We all know it’s important.
Laura: If you can do it at least once a year if you’re in another country, that’s better than nothing. But twice year is definitely optimal.
Laura: There’s definitely more to cover with ulcerative colitis. Certainly we didn’t get everything. But I think for this particular young man, there’s probably a bunch of things that we talked about that he’s not currently doing or maybe not focusing on as much. Hopefully that will get him started on some improvements. We want him to feel better. And it’s really kind of you, Sophia, to be so worried about your brother.
Laura: Hopefully you can rely this message to him, maybe let him listen to the podcast. Let us know how he does if he makes some of these changes and he sees some improvements in his symptoms.
Kelsey: Awesome. Well take care, Laura.
Laura: Thanks. You too, Kelsey.